Abstract / Summary
Endosomal dysfunction is a presymptomatic hallmark of neurodegeneration. Recent evidence highlights dysregulation of endosomal pH as a central pathogenic hub in Alzheimer's disease (AD); however, the mechanisms linking pH shifts to neurodegeneration remain incompletely defined. Here, we use a quantitative model of endosomal acidification driven by proton pumping via the vacuolar ATPase, proton leak via the endosomal Na⁺/H⁺ exchanger NHE6, and other ion-regulating elements. The model recapitulates how downregulation of NHE6 in AD promotes endosomal hyperacidification, potentially triggering maladaptive phenotypic plasticity, an initially adaptive response that becomes pathological. Analysis of human brain datasets reveals reciprocal enrichment of NHE6 in neurons and the related NHE9 in glia, with NHE6 co-expression networks enriched for synaptic signalling. Systematic curation of NHE6 patient variants indicates that loss-of-function is associated with late regression, consistent with progressive endosomal hyperacidification, supporting a conceptual framework where early compensation transitions to neurodegeneration. Mathematical analyses calibrated for neuronal endosomes reveal a saturable relationship between luminal pH and NHE6 dosage, with threshold-like behaviour below ~50% expression that hyperacidifies endosomes, correlating with AD severity. Our model suggests this pH shift may exponentially accelerate Aβ oligomerization and enhance β-secretase activity. Furthermore, Aβ oligomerization estimates correlate with dysregulation of calcium signalling and synaptic dysfunction. Model findings are compared with experimental results from NHE6-null mice and a cell culture model of AD. Drawing parallels to cancer, we propose that endosomal pH serves as a conserved regulator of adaptive-to-maladaptive transitions. Restoring physiological endosomal pH may offer a therapeutic window to prevent irreversible neurodegeneration in AD.